Contact:

The Cancer Research Unit, Department of Biology,
University of York,
York. YO10 5DD. UK.

Tel: +44 (0) 1904 328711 Fax: +44 (0) 1904 328710

Email: biol49@york.ac.uk

The Cancer Research Unit

What Every Man Should Know About Prostate Cancer

Prostate cancer is a disease of ageing. This means that most men will not realise they have prostate cancer until they are well into their 50s or perhaps even their 60s. This is not to say that the cancer was not there before then, but the symptoms only become apparent at that age. There is a very strong National feeling that screening for prostate cancer based on a blood test for a protein called prostate specific antigen (PSA) should be introduced under the National Health Service. What most men do not know is that they have a right to such a test, funded by the NHS, on demand from their GP. If a man is worried that he has prostate cancer then he can have this test done.

What are the signs to look for?

The symptoms of prostate cancer are usually associated with a stoppage or obstruction in the flow of urine. The prostate acts as a tap underneath the bladder and if a cancer is present it often presses on the passage and closes the tap. However, the same symptoms in 99 out of 100 cases are produced by a benign disease (which is not cancerous) known as benign prostatic hyperplasia. This disease can be treated and urine flow restored. However, sometimes during the treatment a cancer which was previous not found can be picked up.

PSA Testing: an indicator of prostate cancer from a blood sample

If you go to the doctor with such symptoms he will undoubtedly recommend a PSA test. The normal level of PSA in a middle aged man is around 3.7ng (1000th million of a gram) per ml of blood: this is a very sensitive test indeed. If your level varies perhaps over 5ng per ml then there is an indication that something is wrong but not necessarily cancer.

What happens next ……..

What the doctor should then do is to monitor your PSA over a period of perhaps a year looking every 3 or 6 months for a steady increase in that PSA level or if the PSA level is already high then you will be referred immediately to attend a urology clinic in the local hospital when a digital rectal examination will be carried out. As the name implies this involves a finger and the rectum and what the urologist will look for is anything hard within the prostate. Cancers have a hard structure and it’s a little bit like feeling a pea on the edge of a soft fruit for example. If this is the case then the prostate will be biopsied to check whether it is cancerous or not.

Gleason Grading of Prostate Cancers

Prostate cancers are treated based on something called their Gleason Grade. This Gleason Grade is a scale from 1-5 (5 being the worst) and is often referred to as a score where the two most common cancer types found after biopsy are added together. For example, if someone has a Gleason 3 tumour in one biopsy and a Gleason 4 in another he will be described as a Gleason Score of 7 (3+4). This score has a major influence on decisions for treatment. Gleason 4 tumours tend to do much worst than Gleason 1 & 2 with Gleason 3 being something of a grey area for decision. There is considerable research being carried out at the moment trying to determine a better, more genetically based system than that established by Gleason 40 years ago. You may read about some of these in the newspapers and on the internet but they are not all as established, and Gleason Grading remains a reliable test even after this long time, a testament to Prof Donald Gleason who devised it (in 1966!).

If cancer is found then there are three different routes of treatment:-

Low Grade Cancer

If the tumour is found to be a low grade cancer the options are really now two-fold. Firstly, you can have surgery to remove your prostate. This is a major operation but is at the moment recommended for younger men with early stage prostate cancers. There are potential side affects which should be discussed with the Clinician involved.

Another alternative is to do nothing, or more precisely to monitor the progress of the cancer because we are beginning to discover that many cancers are not particularly dangerous and that there is a substantial amount of over-treatment of prostate cancers with associated side affects, which could be eliminated. This is known as active monitoring and would involve repeated testing. If anything were found to be changing, then the decision to treat would be taken immediately.

Higher Grade Cancer – but still within the prostate

If cancer is found and it is at the extreme edge of the prostate where there is a chance that it has escaped from the prostate (it is normally tumours outside of the prostate which are fatal in the longer term) then radiotherapy is often an option. This takes two forms; conformal radiotherapy, where a high energy beam of radiation is focussed onto the area of the cancer and essentially burns it out. This is often highly effective and has a long established tradition as a cancer treatment. A more sophisticated version of this is called Brachytherapy which involves planting little radioactive seeds all around the tumour so that a cross fire is set up which achieves the same as the external beam radiotherapy. This is very popular and Leeds is a major International centre in the development of this technology. The seeds can set off detectors in airport security sometimes! So it is not always a good idea to plan a Foreign holiday immediately after treatment.

Advanced High Grade Prostate Cancer

The last stage of prostate cancer to be discovered is a high Gleason Grade with evidence of escape outside of the prostate. This would normally be to little nodules called lymph nodes, but prostate cancer also has a particular liking for bone marrow and lodges there and begins to form new tumours know as metastases. These can be revealed by a radiographic method called a bone scan or scintography and if a Clinician sees a high Gleason grade in your tumour he will often recommend such a bone scan. Under these conditions it is not recommended that the prostate be removed or indeed that radiotherapy should be employed with quite the same precision as the bone marrow is difficult to target. The recommendation here would be for medical therapies, almost certainly based on drugs that block male sex hormones. These have some side affects, clearly, but in certainly more than in 80% of cases, show an instant and remarkable shrinkage of any tumours outside of the prostate. The warning is that this treatment is time-limited. New drugs in this area are being produced all the time with more efficacy and lower side affects and this is certainly something where management of prostate cancers will improve over the next 4-5 years.

Honesty is the best policy to ensure the best treatment

The important thing in all of these treatments is to be absolutely honest with the GP and Urologist about dietary and life style matters. If you have taken some patent medicine, perhaps procured on the internet or recommended by a friend with prostate cancer you must let the Clinician know, if not then it may compromise your whole treatment schedule.

The Cancer Research Unit draws its research funding from a number of sources both local, National and International.